Abstract

Background:

Cirrhosis now has the 10th highest mortality rate worldwide. Most cirrhosis deaths are caused by the emergence of clinical decompensation, and 4%–12% of those who have the disease, experience at least one episode of decompensation per year. These patients are highly susceptible to infections due to increased systemic inflammation leading to kidney failure and death. Aim was to study the efficacy of albumin in reducing episodes of decompensation, preventing bacterial infection, kidney dysfunction and mortality.

Methods:

Study involved patients with Child B or C cirrhosis with albumin level below 30 g per litre, who were administered 20% human albumin weekly with standard medical treatment for 3 months or or till serum albumin levels are 4.0 g/dL (whichever is earlier) and compared with age and sex matched controls who received only standard medical treatment. The primary end-point was 6 month mortality, and the secondary end-points were reduction in infections, kidney dysfunction, ascites recurrence, hepatic encephalopathy, gastrointestinal bleed and complications of cirrhosis.

Results:

From September 2021 to January 2023, 88 cases and 86 controls were taken and followed up for 6 months. Overall 6-month survival was not statistically significant between groups (95.1% vs 91.9%; p=0·330). Incidence of Recurrence of ascites (34.09% v/s 59.3%, P<0.001), Kidney dysfunction (6.8% v/s 24.4%, P<0.001), hepatic encephalopathy (15.9% vs 37.2%, P=0.015), Spontaneous bacterial peritonitis (7.9% vs 18.6%, P=0.002), Non SBP infections (7.9% vs 18.6%, P=0.038) were significantly less in cases as compared with controls, however Gastrointestinal bleed (14.8% vs 17.4%, P=0.632) was not statistically significant.

Conclusion:

Long-term Human albumin acts as a disease modifying treatment in patients with decompensated cirrhosis.